Objective To explore the impacts of optimizing emergency nursing care process on success rate of rescue and incidence of adverse reactions in patients with acute chest pain. Methods A total of 90 emergency patients with acute chest pain, admitted between January 2022 and December 2023, were selected as study participants. Patients were randomly assigned to either the control group or the observation group using a random number table method. The control group received routine care, while the observation group underwent an optimized emergency nursing care process. Comparisons between the two groups were made for the following outcomes: rescue and hospitalization time, rescue success rate, pain intensity, incidence of adverse reactions, mental status, and nursing satisfaction. Results Compared with the control group, the rescue and hospitalization time of the observation group were shorter ( p < 0.01). Compared with the control group, the rescue success rate of the observation group was higher (82.22% vs. 97.78%; p = 0.013). The visual analogue score (VAS) scores of the observation group at 30 min, 60 min, 120 min and 240 min after rescue were lower than those of the control group ( p < 0.01). Compared with the control group, the incidence of adverse reactions of the observation group was lower (20.00% vs. 4.44%; p = 0.024). Compared with the control group, the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores of the observation group were lower after nursing ( p < 0.01). Compared with the control group, the nursing satisfaction score of the observation group was higher ( p < 0.01). Conclusion The optimized emergency nursing care process for patients with acute chest pain is associated with relief of pain, a decrease in the occurrence of negative psychology and adverse reactions, as well as an effective improvement in the success rate of rescue.

Purpose To quantitatively evaluate fundus tessellation density (FTD) in children with early-onset high myopia (eo-HM) using artificial intelligence (AI)–assisted image analysis and to explore its association with axial length (AL). Methods This cross-sectional study included children aged ≤6 years with eo-HM, defined as spherical equivalent (SE) ≤ −6.00 D and/or AL > 26.00 mm. Cycloplegic refraction, AL measurement, and ultra-widefield fundus photography were performed. A deep learning–based algorithm quantified FTD across concentric macular zones (1 mm, 3 mm, 6 mm) and anatomical sectors. Correlation and multivariate regression analyses were used to assess associations between FTD and AL. Results A total of 47 eyes from 31 children were analyzed. Mean SE was −9.35 ± 3.74 D and AL was 25.70 ± 1.50 mm. FTD declined from center to periphery ( p < 0.001), with greater values in nasal and inferior sectors at 6 mm. Overall FTD correlated with AL ( r = 0.46, p = 1.47 × 10 −3 ). In univariate regression, FTD significantly predicted AL ( β = 18.16, p = 1.76 × 10 −5 , R 2 = 0.352). Multivariable analysis showed that FTD in the 6 mm nasal and superonasal sectors remained independently associated with AL after adjusting for age and sex. Conclusion AI-assisted quantification of FTD provides a sensitive and objective measure of early retinal changes in eo-HM. Regional FTD, especially in nasal and perifoveal regions, is strongly associated with axial elongation and may serve as a useful biomarker for early diagnosis and monitoring of pediatric high myopia.

Background Recent evidence has suggested that primary aldosteronism (PA) is the predominant cause of secondary hypertension and is linked to adverse left ventricular (LV) remodeling. However, few studies have investigated the potential associations of aldosterone-to-renin ratio (ARR), an important parameter for PA screening, with the risk of adverse LV remodeling in the Chinese population. This study aimed to investigate the associations of ARR, plasma aldosterone concentration (PAC), and plasma renin concentration (PRC) with adverse LV remodeling in a population from Guangxi, China. Methods The analyzed data were primarily obtained from the First Affiliated Hospital of Guangxi Medical University and the First People’s Hospital of Yulin City during the period from September 2022 to March 2024. A total of 724 participants (mean age: 56.4 ± 14.3 years, 71% with hypertension) who underwent aldosterone–renin testing and echocardiography were included in the study. Data on demographics, clinical history, and medications, including calcium channel blockers and mineralocorticoid receptor antagonists (MRAs), were collected. We applied a generalized linear model (GLM) and a multivariable logistic regression model to estimate the relationships between ARR, PAC, and PRC with the risk of adverse LV remodeling and left ventricular hypertrophy (LVH) and further explored the dose–response relationship. Results Of the 724 participants included in this study, GLM revealed that ARR was associated with greater left atrium size, left ventricular end-diastolic diameter, left ventricular mass, and left ventricular mass index. In adjusted multivariable regression analyses, one standard deviation (SD) of ARR emerged as a significant predictor of LVH occurrence [OR = 1.531 (95%CI, 1.041–2.251), p = 0.030], and compared with the first tertile of ARR, the third tertile of ARR had a 2.106-fold higher risk of LVH ( p -trend <0.05), especially in participants without mineralocorticoid receptor antagonists (MRA). Furthermore, a significant dose–response relationship was observed between ARR and LVH risk ( p overall <0.001, p non-linear = 0.079; p overall tests the overall association, while p non-linear tests for a non-linear trend between ARR and LVH risk). Conclusion Elevated ARR is associated with an increased risk of adverse LV remodeling, and the presence of LVH may even occur at ARR levels below the clinical standard range, suggesting that ARR could serve as an early indicator of cardiac structural changes. Our results revealed that earlier targeted intervention with MRAs may be beneficial. However, this hypothesis requires confirmation in prospective and interventional studies, particularly those assessing the clinical and cost-effectiveness of early MR blockade. Our study provided a foundation for further exploration of this approach.

This review explores the concept of dilutional rheomodulation in dermal fillers with the addition of platelet-rich plasma (PRP) and its potential to improve both aesthetic and regenerative outcomes. PRP is a biological product rich in growth factors and cytokines derived from the patient’s own blood, which plays a significant role in tissue regeneration and healing. According to previous studies that utilized titrated aqueous solutions as solvents, it is hypothesized that incorporating PRP into different dermal filler formulations may be effective for modulating the rheological parameteres of dermal fillers while providing regenerative and immunomodulatory properties, potentially improving biocompatibility, injectability, distribution, and overall tissue integration as suggested by preliminary investigations. This combined approach may reduce severe adverse effects associated with filler injections while enhancing their biostimulatory effects. Moreover, PRP has been shown to stimulate collagen production and promote skin regeneration, which may extend the filler’s longevity and improve skin texture and elasticity. Although early studies suggest positive outcomes, further clinical trials are needed to determine optimal dilution ratios, establish best practices, and assess long-term safety and efficacy. This review highlights the promising potential of PRP-filler combinations in advancing aesthetic procedures through the integration of immediate volumization with regenerative skin enhancement.

The treatment of post-acute sequelae to COVID-19 (PASC) remains challenging. Defining PASC solely based on symptoms and disease duration in clinical trials can mask the potential for recovery in specific patient subgroups. A good design for future research requires a clear classification of various PASC according to different pathogenesis under the general diagnosis. Here, we discuss four key types of pathogenesis that should be recognized to determine the enrollment of PASC patients.

Background Career decision-making difficulties are often associated with negative outcomes, including decreased motivation for learning, weakened professional identity, increased burnout, and a higher risk of turnover. However, most research has concentrated on the overall levels of career decision-making difficulties, overlooking the potential variations among different student subgroups. This gap hinders the creation of targeted intervention strategies. Purpose This study aimed to identify latent profiles of Career decision-making difficulties among undergraduate nursing students and explore factors associated with these profiles. Design A cross-sectional study. Methods A convenience sampling method was employed to recruit 562 undergraduate nursing students from three universities in China. Participants completed validated measures assessing demographics, learning engagement, perceived social support, and career decision-making difficulties. Latent profile analysis identified distinct profiles of career decision-making difficulties, and multinomial logistic regression examined the associated factors. Results Three distinct career decision-making difficulties profiles emerged: multidimensional decision-making block (58.5%), knowledge-action disconnection (34.0%), and information-driven advantage (7.5%). Perceived social support, learning engagement, and class leadership status were significantly associated with these career decision-making profiles. Conclusion Nursing students face diverse career decision-making challenges, highlighting the need for tailored institutional support. Students in the “Multidimensional Decision-Making Block” profile may benefit from structured career development courses. For the “Knowledge-Action Disconnection” profile, strengthening career information processing is crucial. Enhancing learning engagement, decision-making skills, and support networks can reduce uncertainty and better prepare students for their professional futures.

Over the past decade, Shewanella spp. have been increasingly recognized as opportunistic pathogens, particularly in patients with malignancies, neutropenia, severe heart failure, renal insufficiency, and hepatobiliary diseases. Shewanella indica is a rarely reported species within the Shewanella genus, and its role in human infection remains poorly documented. In this study, we report the first case of S. indica isolated from the stool of a critically ill 72-year-old man in Serbia with multiple pre-existing comorbidities and co-infections. Initial identification using the VITEK 2 system misclassified the strain as Shewanella algae , while species-level identification by the matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) was inconclusive. However, whole-genome sequencing (WGS) definitively identified the isolate as S. indica and revealed a multidrug-resistant profile together with numerous virulence-associated genes. Minimum inhibitory concentrations (MICs) were determined for 32 antibiotics, although interpretation was constrained by the lack of species-specific breakpoints. This case highlights the diagnostic challenges in differentiating Shewanella indica , discusses its possible clinical roles, and underscores the value of genomic tools for accurate identification. It also reinforces the importance of recognizing rare pathogens in complex clinical scenarios.

Purpose Recent research suggests that acupuncture holds significant potential in the treatment of primary osteoporosis. However, a comprehensive bibliometric analysis on this topic has not yet been conducted. Therefore, the aim of this study is to investigate the research hotspots related to acupuncture for primary osteoporosis. Methods The Web of Science Core Collection database was searched for relevant publications from 2000 to 2025. Countries, institutions, authors, keywords, and literature were analyzed and visualized using bibliometric software, including CiteSpace 6.4.R1, VOSviewer 1.6.20, BICOMB, gCLUTO, SPSS 27.0, and Microsoft Charticulator, to investigate scientific achievements, research collaboration networks, research hotspots, and research trends. Result This study analyzed 775 publications. “Osteoporosis International” is the most-cited journal, and the United States of America conducts the most research output and impact. Guangzhou University of Chinese Medicine is the most prolific institution studying acupuncture for primary osteoporosis; Cortet Bernard and Kanis JA are the authors with the most relevant literature and citations in this field. Keyword analysis revealed that the most frequently occurring term. Additionally, the analysis of the keyword analysis showed that the keyword with the highest number of occurrences was postmenopausal women; The results of the keyword and literature analysis indicate that postmenopausal women, osteoporosis-related complications, Traditional Chinese Medicine, and osteoporosis prevention are emerging as new research hotspots. This bibliometric study provides valuable insights into the research status and trends in acupuncture for primary osteoporosis over the past two decades. Conclusion Supported by high-quality research, acupuncture is increasingly recognized as an effective treatment for primary osteoporosis. Future research should focus on postmenopausal women, osteoporosis-related complications, Traditional Chinese Medicine, and the prevention of osteoporosis.

Objective To construct and evaluate a comprehensive training pathway based on simulated operation training to improve the mental health literacy and clinical communication skills of junior dental undergraduate students. Methods A quasi-randomized controlled pre-post mixed-methods design was used, with 60 lower-year dental students enrolled. The intervention group received 5-module training (VR scenario cognition, stress regulation, simulation integration, standardized patient communication, reflective reinforcement), while the control group received conventional teaching. Assessments were conducted at T0 (baseline), T1 (post-Module 3), T2 (post-Module 5), and T3 (1 month post-internship) using tools including DANVA-2, MHL-Q, SEGUE, JSE-HP, and CD-RISC-10. Results At T3, the intervention group showed significantly higher scores than the control group: DANVA-2 accuracy (80.7% ± 6.1% vs. 66.2% ± 6.5%, Cohen’s d = 2.31), MHL-Q (71.1 ± 4.8 vs. 60.8 ± 5.4, d = 2.05), SEGUE (80.9 ± 5.9 vs. 67.2 ± 6.0, d = 2.28), and CD-RISC-10 (28.4 ± 3.5 vs. 23.2 ± 3.7, d = 1.46) (all p < 0.05). Emotional recognition (OR = 1.12, 95%CI: 1.06–1.18) and communication effectiveness (OR = 1.15, 95%CI: 1.09–1.21) independently predicted clinical integration ability. Conclusion The simulation-based training pathway improves dental students’ MHL, CC skills, and psychological resilience, and correlates with better clinical performance, providing empirical support for dental education.

Introduction To compare the efficacy of combination therapy using 0.05% cyclosporine A (CsA) and absorbable punctal plugs with that of CsA monotherapy in patients with Sjögren’s syndrome-associated dry eye (SS-DE) using a paired-eye randomized controlled design. Methods This prospective, randomized, observer-masked, paired-eye clinical trial included 21 patients (42 eyes) with SS-DE. One eye of each patient received 0.05% CsA plus an absorbable lower punctal plug, whereas the contralateral eye received CsA monotherapy. Clinical assessments, including the Ocular Surface Disease Index (OSDI), visual analog scale (VAS), noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and corneal dendritic cell (DC) density (measured via in vivo confocal microscopy), were conducted at baseline and after 3 months. Intra-and intergroup comparisons were performed using paired t-tests. Pearson’s correlation and linear regression analyses were used to evaluate the association between ΔVAS and ΔOSDI. Results After 3 months, both groups showed significant improvements across all parameters ( p < 0.01). The combined treatment group demonstrated significantly greater improvements in NIBUT ( p < 0.01), TMH ( p < 0.05), DC density ( p < 0.01), and VAS scores ( p < 0.01) than the CsA monotherapy group. A significant positive correlation between ΔVAS and ΔOSDI was found in the combined treatment group (r = 0.528, p = 0.014), but not in the CsA monotherapy group (r = −0.172, p = 0.456). Conclusion Combination therapy with 0.05% CsA and absorbable punctal plugs yields superior improvements in both objective clinical signs and subjective symptoms compared to CsA monotherapy in SS-DE. This approach may enhance drug efficacy and patient comfort, offering an optimal therapeutic strategy for autoimmune-related dry eye. Clinical trial registration [ ClinicalTrials.gov ] Identifier: NCT07171710.